35+ Years in the Cath Lab: “Persistence, Dedication, and Satisfaction”

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Cath Lab Digest and Syed M. Ahmed, MD, talk with Liberato A. Iannone, MD, Cardiac Cath Lab Director, Mercy Medical Center, Des Moines, Iowa.

Dr. Liberato Iannone is the Director of Cardiac Catheterization at Mercy Hospital in Des Moines, Iowa. He has been in the field of interventional cardiology since its early days. Dr. Syed Ahmed asked Dr. Iannone to share his personal experience in the field with Cath Lab Digest.

How long you have been working as an interventional cardiologist?

I did my first left heart catheterization in 1970 and coronary intervention in 1979.

Where did you receive training for coronary intervention?

Initially, I attended the Dr. Andreas Gruentzig course in Sweden. Later, I visited different radiologists and cardiologists who were “experimenting” in this field. I should point out that what you see in interventional cardiology today is the fruit of years of experiment, discussion, and sharing of knowledge.

How did hospital administration respond when you first started the cath lab in Des Moines?

Well, it was not smooth sailing. It required a lot of discussion, understanding, and teaching. I also invited physicians who already had established a cath lab to come to our cath lab and help convince our administration of the need for a cath lab where percutaneous intervention could be done.

How was the hospital staff response when you first started percutaneous intervention in the cath lab?

They were motivated after seeing positive outcomes. Once we started doing ST-elevation myocardial infarctions (STEMIs), more and more people wanted to work in our cath lab.

How many cardiac catheterizations and coronary interventions have you done so far?

It is difficult to determine the number of cardiac catheterizations and interventions I have done in my career. At Mercy Hospital, we do 4-5,000 coronary and peripheral interventions per year. All interventionalists do almost an equal number of cases within that number.

How did patients respond when they first learned about the existence of the cath lab?

They were excited to have another option besides having open-heart surgery. When I did my first angioplasty, I had my cardiovascular surgeon stand by me. He felt he would lose his job if this procedure became standard. Well, the vessel closed after 15 minutes and the patient became symptomatic, requiring urgent coronary artery bypass graft surgery. This patient went on to live for 12 years and die of cancer. My second and third patients are still alive and heart-wise, doing well. Now there are more cardiovascular surgeons and interventional cardiologists than we had 35 years ago.

Were you involved in training physicians for cardiac catheterizations and coronary interventions?
We had our own fellowship program from 1990 to 2002. Now fellows from accredited programs such as the University of Iowa and University of Nebraska rotate into our lab. We also get practicing physicians from low-volume centers who want to sharpen their skills in the field of interventional cardiology.

Was it difficult to continue on after complications occurred?

As they say, “Good judgment comes from experience, experience comes from bad judgment.” You want to learn from your mistakes. So, after a complication, I like to review my whole case and discuss it with my colleagues to see what went wrong and how to avoid it in the future.

How many cath labs are at Mercy Hospital in Des Moines?

We have four designated coronary and peripheral labs in the Mercy main hospital, and one in the Mercy West Lakes hospital. There are two electrophysiology labs in Mercy main and one in the Mercy West Lakes hospital.

How many interventionalists and cath lab staff are there?

Nine interventionalists work at both campuses. There are 19 registered nurses, 18 radiology technologists, and 5 ancillary staff who rotate in coronary and EP labs in the Mercy main and Mercy West Lakes hospitals.

As you have seen so many technologies either stay or go, how do you incorporate new devices or procedures into your practice?

We have 9 interventionalists at the Mercy campus and a total of 16 interventionalists in our group working in other facilities. Every other month, we have mandatory meetings in which literature review of new and existing technologies is discussed. A majority of interventionalists must suggest we incorporate new technology and similarly, a majority must agree in order to remove existing technology from our cath lab. Also, our interventionalists often attend didactic or hands-on experience courses, and when they return, they share their experience with me. From time to time, I will discuss it with other interventionalists in the group and hospital administration.

Do you have any advice for new physicians working in the cath lab?

Three words: persistence, dedication, and satisfaction. You may lose the excitement of doing STEMIs after the first few years of practice (especially if you need to work in the middle of the night). But, if your dedication and persistence continues, you will earn a lot of respect from patients, and your colleagues, hospital staff, and community. You may be walking in a public place with your family and someone greets you, and tells his and your family, “This man saved my life!” You will feel proud of yourself and immensely satisfied. It feels like all of your hard work has paid off.

Any thought about the ergonomics of your work and how it has evolved over time?

Cardiac catheterization could only be done under fluoroscopy in the beginning. Patients would lay in a cradle and the patient would have to move so we could obtain different views. Now we have tables that can slide and C-arms that can rotate. Cardiac catheterizations were done with 8 French sheath in the 1970’s, but now it can be done with a 4 or 5 French sheath. Lead jackets are a great deal lighter than before as radiation exposure reduced with improved technology.

How have you seen the roles of staff in the cath lab evolve over time?

As the equipment and and technique in interventional cardiology continue to improve, the role of cath lab staff continues to evolve. It seems like they are in much better shape to help interventional cardiologist in long, difficult cases.

Any final thoughts?

To me, interventional cardiology is the most rewarding field. If I had to choose my career again, I would choose the same.

Dr. Iannone can be contacted at [email protected]
 
A sampling of Dr. Iannone’s publications:

  1. Iannone LA. Coronary arteriography. Circulation. 1973 Apr;47(4):913.
  2. Iannone LA, Duritz G, McCarty RJ. Myocardial infarction in the newborn: a case report complicated by cardiogenic shock and associated with normal coronary arteries. Am Heart J. 1975 Feb;89(2):232-235.
  3. Bates JD, Iannone LA, Phillips SJ, Anderson J, Murphy J. Postinfarction ventricular septal perforation: a case report. J Iowa Med Soc. 1976 Feb;66(2):55-57.
  4. Phillips SJ, Zeff RH, Kongtahworn C, Gordon DF, Iannone LA, Brown T. Myocardial revascularization in patients with unstable angina. J Thorac Cardiovasc Surg. 1977 Jul;74(1):159-60.
  5. Phillips SJ, Kongtahworn C, Zeff RH, Iannone LA, Brown TM, Kreamer R, Gordon DF. A new left ventricular assist device: clinical experience in two patients. Trans Am Soc Artif Intern Organs. 1979;25:186-191.
  6. Phillips SJ, Zeff RH, Kongtahworn C, Iannone LA, Brown TM, Gordon DF. Anoxic hypothermic cardioplegia compared to intermittent anoxic fibrillatory cardiac arrest. Clinical and metabolic experience with 1080 patients. Ann Surg. 1979 Jul;190(1):80-3.
  7. Zeff RH, Iannone LA, Kongtahworn C, Brown TM, Gordon DF, Benson M, Phillips SJ, Alley RE. Coronary artery spasm following coronary artery revascularization. Ann Thorac Surg. 1982 Aug;34(2):196-200.
  8. Iannone LA, Brown TM, Wickemeyer WJ, Gordon DF. Emergency coronary reperfusion for evolving myocardial infarction. J Iowa Med Soc. 1982 Aug;72(8):325.
  9. Iannone LA, Brown TM, Phillips SJ, Wickemeyer WJ, Zeff RH, Wheeler WS, Kongtahworn C, Rough RR, Skinner JR, Toon RS, et al. Percutaneous transluminal coronary angioplasty: an added modality for the treatment of the patient with coronary heart disease. Cardiologia. 1983 Jul;28(7):625-633.
  10. Iannone LA, Brown TM Jr, Wickemeyer WJ, Wheeler WS, Gordon DF, Rough RR, Phillips S, Zeff R, Kongtahworn C, Skinner J. Percutaneous transluminal coronary angioplasty: evolution and changing concepts. Iowa Med. 1986 Jun;76(6):271-275.
  11. Zeff RH, Kongtahworn C, Iannone LA, Gordon DF, Brown TM, Phillips SJ, Skinner JR, Spector M. Internal mammary artery versus saphenous vein graft to the left anterior descending coronary artery: prospective randomized study with 10-year follow-up. Ann Thorac Surg. 1988 May;45(5):533-536.
  12. Phillips SJ, Zeff RH, Kongtahworn C, Skinner JR, Toon RS, Grignon A, Kennerly RM, Wickemeyer W, Iannone LA. Percutaneous cardiopulmonary bypass: application and indication for use. Ann Thorac Surg. 1989 Jan;47(1):121-123.
  13. Phillips SJ, Kongtahworn C, Zeff RH, Skinner JR, Toon RS, Grignon A, Spector M, Iannone LA. Disrupted coronary artery caused by angioplasty: supportive and surgical considerations. Ann Thorac Surg. 1989 Jun;47(6):880-883.
  14. Phillips SJ, Tannenbaum M, Zeff RH, Iannone LA, Ghali M, Kongtahworn C. Sheathless insertion of the percutaneous intraaortic balloon pump: an alternate method. Ann Thorac Surg. 1992 Jan;53(1):162.
  15. Iannone LA, Rayl KL. Peripheral vascular disease. Iowa Med. 1992 Jun;82(6):261-262.
  16. Iannone LA, Anderson SM, Phillips SJ. Coronary angioplasty for acute myocardial infarction in a hospital without cardiac surgery. Tex Heart Inst J. 1993;20(2):99-104.
  17. Iannone LA, Toon RS, Rayl KL. Percutaneous transluminal angioplasty of the innominate artery combined with carotid endarterectomy. Am Heart J. 1993 Dec;126(6):1466-1469.
  18. Iannone LA, Underwood PL, Nath A, Tannenbaum MA, Ghali MG, Clevenger LD. Effect of primary balloon expandable renal artery stents on long-term patency, renal function, and blood pressure in hypertensive and renal insufficient patients with renal artery stenosis. Cathet Cardiovasc Diagn. 1996 Mar;37(3):243-250.
  19. Smith LG, Duval S, Tannenbaum MA, Johnson Brown S, Poulose AK, Iannone LA, Larson DM, Ghali MG, Henry TD. Are the results of a regional ST-elevation myocardial infarction system reproducible? Am J Cardiol. 2012 Jun 1;109(11):1582-1588.

Cath Lab Digest also had the chance to speak with Dr. Iannone. We share some of his memories, below:

What was the field like in your early days of working as a cardiologist?

At that time, as a cardiologist, all you did was angiogram and call the surgeon, which is basically what we did at Walter Reed.


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